Schizophrenia beyond the brain

The Wilson Quarterly has an excellent article about the rebirth of interest in how social experiences affect the development of schizophrenia.

It’s written by the brilliant anthropologist Tanya Marie Luhrmann, who tracks how the enthusiasm for a completely neurobiological explanation for the disorder has now begun to wane.

It’s worth saying that this extreme neurobiological focus has really been an American phenomenon.

While it’s true to say that psychiatry has taken a distinct neurobiological turn across the world, the mantra that ‘schizophrenia is a brain disease’ and only needs to be understood in terms of brain function has been most strongly championed in the United States.

For somewhat mysterious reasons, and not without a touch of irony, American psychiatry has been subject to quite striking mood swings over the past century.

The ‘Freudian takeover’ only really occurred in the US, and was overturned by the diagnostic manual championing ‘mid-Atlantics’ who created the DSM-III.

Subsequently, a dominant current of thought emerged that mental illnesses could be understood as ‘brain disorders’ – a concept massively promoted and funded by drug companies. Searches for the ‘gene for schizophrenia’ and the ‘brain circuit for depression’ were all the rage, even if they seem a little naive in hindsight.

In Europe, however, social psychiatry – where mental disorders are seen within a social context – remained widely taught. In the UK, it had more an an epidemiological flavour, where on the continent it was more focussed on analysing the cultural meaning of mental illness.

Nevertheless, Luhrmann’s article is an excellent overview of how psychiatry has started to look ‘beyond the brain’, although we’d hope it doesn’t lose sight of it while gazing at the horizon

My only significant problem was that the article repeats the ‘people with schizophrenia do better in the developing world’ claim, which is so over-general as to be useless.

Other than that though, an excellent incisive article and one of the best pieces you’re likely to read in a while.

3 thoughts on “Schizophrenia beyond the brain”

The blog Ruminations on Madness had some interesting posts on Tanya’s work, including this article, and there is some back and forth in the comments with Daniel Lende.

Re the “developing world” & problem of over-generalizations, Nev Jones linked me to regional data from the Worldwide-Schizophrenia Outpatient Health Outcomes or W-SOHO study suggesting a better clinical outcome but a worse functional outcome in regions other than “North Europe” (See, e.g., Haro et al’s “Cross-national clinical and functional remission rates.”) On the other hand, urban birth/upbringing appears to be a significant risk factor “independent of differences in the age, sex and ethnic population structure of different geographical areas, and correlated to a number of socio-environmental factors including ethnic density, social cohesion, social fragmentation, deprivation, and inequality” (Kirkbride et al., 2012).

Thanks for the shout-out, CC. I do think I was too hard on TL in my critique (still feel guilty about it), but at the same time continue to feel very ambivalent about the article’s oversimplification of American psychiatry’s trajector(ies) of change, various choices re language and phrasing (admittedly probably made for primarily rhetorical rather than substantive reasons), etc.

There’s certainly something to be said for painting in broad strokes (especially for a non-specialist audience), but it’s not just the devil that’s in the details, it’s also often what’s most important for us (“specialists” and non-specialists) to critically grapple with… The nuances of the various international outcome studies (including W-SOHO) are only one example.